Femoral lengthening might impair physical function and lead to structural changes in adjacent joints: 10 patients with 27 to 34 years' follow-up

Patrick A Bjørge, Anne-Therese Tveter, Harald Steen, Ragnhild Gunderson, Joachim Horn, Patrick A Bjørge, Anne-Therese Tveter, Harald Steen, Ragnhild Gunderson, Joachim Horn

Abstract

Background and purpose - Literature describing long-term functional outcome and osteoarthritis (OA) in adjacent joints after femoral lengthening is rare. We evaluated physical function and the presence of radiographic OA in adjacent joints in 10 patients ≥ 27 years after femoral lengthening.Patients and methods - We conducted a cross-sectional study of 10 patients treated by unilateral femoral lengthening. Follow-up was between 27 and 34 years. Physical function was evaluated by the 30-second sit-to-stand (30sSTS) and a stair test and was compared with reference values. 4 single-legged hop tests were used to assess difference in physical function between the lengthened and contralateral limb. Radiographic OA was evaluated by joint space width (JSW) and Kellgren and Lawrence (KL) classification.Results - The patients scored worse compared with reference values on the 30sSTS and stair test, and worse on the lengthened limb on the single- and triple-hop test. Radiographic OA was found in the hip or knee in the lengthened limb in 3 of 10 patients based on JSW and 4 of 10 based on KL. No radiographic OA was found in unlengthened limbs.Interpretation - Our results showed impaired physical function both in general and of the lengthened limb. Additionally, we found a possible association between femoral lengthening and radiographic OA in adjacent joints in the long term. However, the sample size of the current study is small.

Trial registration: ClinicalTrials.gov NCT03966573.

Figures

Figure 1.
Figure 1.
Flow chart of patients included in the study.
Figure 2.
Figure 2.
Patient number 5 in the supplementary data table. (A) The right knee with tibiofemoral and femoropatellar Kellgren and Lawrence (KL) grade 2/osteophyte. (B) The left knee with tibiofemoral KL grade 1 and femoropatellar KL grade 0.

References

    1. Barber S, Noyes F R, Mangine R E, McCloskey J, Hartman W.. Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res 1990; (255): 204–14.
    1. Bhave A, Shabtai L, Woelber E, Apelyan A, Paley D, Herzenberg J E.. Muscle strength and knee range of motion after femoral lengthening: 2- to 5-year follow-up. Acta Orthop 2017; 88(2): 179–84.
    1. Brewster M B S, Mauffrey C, Lewis A C, Hull P.. Lower limb lengthening: is there a difference in the lengthening index and infection rates of lengthening with external fixators, external fixators with intramedullary nails or intramedullary nailing alone? A systematic review of the literature. Eur J Orthop Surg Traumatol 2010; 20(2): 103–8.
    1. Brouwer G, Tol A V, Bergink A, Belo J, Bernsen R, Reijman M, Pols H, Bierma–Zeinstra S.. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheumatol 2007; 56(4): 1204–11.
    1. Castelein S, Docquier P-L.. Complications associated with bone lengthening of the lower limb by callotasis. Acta Orthop Belg 2016; 82(4): 806–13.
    1. Felson D T, Niu J, Guermazi A, Sack B, Aliabadi P.. Defining radiographic incidence and progression of knee osteoarthritis: suggested modifications of the Kellgren and Lawrence scale. Ann Rheum Dis 2011; 70(11): 1884–6.
    1. Gofton J, Trueman G.. Studies in osteoarthritis of the hip, Part II: Osteoarthritis of the hip and leg-length disparity. Can Med Assoc J 1971; 104(9): 791.
    1. Herring J A. Tachdjian’s pediatric orthopaedics. 4th ed. Philadelphia: Elsevier; 2008.
    1. IPAQ Group . Guidelines for the data processing and analysis of the “International Physical Activity Questionnaire”; 2005.
    1. Jones C J, Rikli R E, Beam W C.. A 30-s chair–stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999; 70(2): 113–19.
    1. Kellgren J, Lawrence J.. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494.
    1. Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block J E, Stevens R, Peterfy C G.. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol 2004; 14(9): 1568–73.
    1. Krieg A H, Gehmert S, Neeser O L, Kaelin X, Speth B M.. Gain of length—loss of strength? Alteration in muscle strength after femoral leg lengthening in young patients: a prospective longitudinal observational study. J Pediatr Orthop B 2018; 27(5): 399–403.
    1. Noyes F R, Barber S D, Mangine R E.. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 1991; 19(5): 513–18.
    1. Paley D. Principles of deformity correction 1st ed. New York: Springer; 2005.
    1. Reid A, Birmingham T B, Stratford P W, Alcock G K, Giffin J R.. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 2007; 87(3): 337–49.
    1. Sakellariou G, Conaghan P G, Zhang W, Bijlsma J W, Boyesen P, D’Agostino M A, Doherty M, Fodor D, Kloppenburg M, Miese F.. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76(9): 1484–94.
    1. Schouten J, Van den Ouweland F, Valkenburg H.. A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. Ann Rheum Dis 1992; 51(8): 932–7.
    1. Sneppen O, Bünger C, Hvid I, Søballe K.. Ortopaedisk kirurgi. Copenhagen: FADL’s Forlag; 2014.
    1. Stanitski D F. The effect of limb lengthening on articular cartilage: an experimental study. Clin Orthop Relat Res 1994; (301): 68–72.
    1. Stevens P M, Maguire M, Dales M, Robins A.. Physeal stapling for idiopathic genu valgum. J Pediatr Orthop 1999; 19(5): 645.
    1. Terjesen T, Gunderson R B.. Radiographic evaluation of osteoarthritis of the hip: an inter-observer study of 61 hips treated for late-detected developmental hip dislocation. Acta Orthop 2012; 83(2): 185–9.
    1. Tveter A T, Dagfinrud H, Moseng T, Holm I.. Health-related physical fitness measures: reference values and reference equations for use in clinical practice. Arch Phys Med Rehabil 2014a; 95(7): 1366–73.
    1. Tveter A T, Dagfinrud H, Moseng T, Holm I.. Measuring health-related physical fitness in physiotherapy practice: reliability, validity, and feasibility of clinical field tests and a patient-reported measure. J Orthop Sports Phys Ther 2014b; 44(3): 206–16.

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